Provider Demographics
NPI:1144952961
Name:360 WELLNESS SOLUTIONS PHYSICAL THERAPY AND REHABILITATION SERVICES
Entity type:Organization
Organization Name:360 WELLNESS SOLUTIONS PHYSICAL THERAPY AND REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-832-8025
Mailing Address - Street 1:194 LOCH LOMOND RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5600
Mailing Address - Country:US
Mailing Address - Phone:760-832-8025
Mailing Address - Fax:
Practice Address - Street 1:194 LOCH LOMOND RD
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5600
Practice Address - Country:US
Practice Address - Phone:760-832-8025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center